Obstetric Brachial Plexus Palsy Health And Social Care Essay

The estimated incidence of OBPP in the UK and the Republic of Ireland is 0.42 [ 1 ] , in the US 1.5 [ 23 ] and in other western states 1-3 per 1000 unrecorded births [ 3,5,9,22,24-30 ] . Variations in the estimated incidence may be explained by differences in populations and in the antenatal and intrapartum direction [ 31,32 ] . A population-based survey from western Sweden estimated that between 1999-2001 the incidence of OBPP was 2.9 per 1000 unrecorded births, and of prevailing OBPP was 0.46 per 1000 births ( REF Lagerkvist ) . . In another survey from Sweden Bager [ 13 ] had antecedently found an addition in the incidence of brachial rete paralysis ( BPP ) from 1.3 per 1000 vaginal bringings in 1980 to 2.2 per 1000 vaginal bringings in 1994. Chauhan et Al. [ 3 ] compared two clip periods ( 1980-1991 1991-2002 ) and found that the incidence of OBPP has non changed significantly ( 0.9 per 1000 and 1.0 per 1000 severally ) . Gurewitsch et Al. [ 10 ] estimated an incidence of 5.8 per 1000 between the old ages 1993 and 2004 and noted that this remained changeless during the period of their survey. Many writers have admitted that an addition in the cesarean subdivision rates over the past few decennaries may hold been counteracted by an increased birthweight. Furthermore, despite the debut of systematic preparation in the direction of shoulder dystocia with usage of standard manoeuvres, manikins and simulators no important decrease of the incidence of OBPP has been noted.Hazard FactorsThe hazard factors for OBPP are foetal, maternal, and obstetric, [ 37 ] the most important being foetal macrosomia [ 3,18,20,22,26-28 ] which is a hazard factor for shoulder dystocia [ 27,38-42 ] . Nesbitt et al conducted a big population based survey and reported the undermentioned rates of shoulder dystocia for single-handed births of nondiabetic female parents: 5.2 % for birthweight 4000-4250g, 9.1 % for 4250-4500g, 14.3 % for 4500-4750g, and 21.1 % for 4750-5000g ( Nesbitt et al. 1998 ) . OBPP after rear of barrel bringings can besides happen, normally in low birthweight foetuss [ 43,44 ] . The upper roots are often affected in these instances and the hurts tend to be more terrible [ 45 ] . Diabetess mellitus [ 22 ] , fleshiness [ 46,47 ] or inordinate weight addition [ 47 ] , maternal age ( & gt ; 35years ) [ 48 ] , maternal pelvic anatomy ( platypelloid, level pelvic girdle ) [ 3,22,27,39,40,49 ] and primiparity [ 50 ] are common maternal hazard factors. Diabetess mellitus is a important hazard factor for OBPP, as it frequently causes foetal macrosomia [ 51 ] . Nesbitt et Al found that the hazard of shoulder dystocia for single-handed births to diabetic adult females was 8.4 % , 12.3 % , 19.9 % , and 23.5 % when the birth weight was 4000-4250g, 4250-4500g, 4500-4750g, or & gt ; 4750g, severally. ( Nesbitt et al. 1998 ) . Mild glucose intolerance in adult females without diabetes is besides associated with hazards of OBPP, proposing that there is a continuum of glucose-insulin impact on foetal growing that is correlated to the hazard of OBPP [ 52 ] . Shoulder dystocia is a major hazard factor for OBPP [ 9,22,24,40,54-57 ] . The reported incidence of OBPP in bringings complicated by shoulder dystocia varies widely from 4 % to 40 % [ 14,57,58 ] and the incidence of lasting brachial rete hurt after shoulder dystocia is 1.6 % [ 59 ] . Although foetal macrosomia is the most important hazard factor for shoulder dystocia and is associated with most of the other hazard factors ( maternal diabetes, multiparity, old macrosomic baby, drawn-out gestation, maternal fleshiness or inordinate weight addition ) , about half of the instances of shoulder dystocia occur in babies & lt ; 4000g ( Acker et al. 1985 ) . The hazard of OBPP is increased by labour abnormalcies. OBPP occurs more often in induced labours [ 52 ] . Cephalopelvic or fetopelvic disproportion ( the size or place of the foetal caput or the foetus precludes transition into the maternal pelvic recess ) is a hazard factor for shoulder dystocia and OBPP. A relentless occipito- posterior place [ 65 ] has been associated with an increased incidence of OBPP. Lurie et al [ 60 ] found no difference in rates of distension or continuance of the 2nd phase in instances with shoulder dystocia and concluded that protracted labour was non a hazard factor for it. Gross et al [ 66 ] showed that a drawn-out 2nd phase increased the hazard of OBPP, but concluded that shoulder dystocia can non be predicted from labour abnormalcies. Weizsaecker et al support the association of drawn-out 2nd phase in labour with OBPP independent of macrosomia, diabetes, and other factors [ 52 ] . Several other surveies considered a drawn-out 2nd phase as a hazard fac tor for shoulder dystocia [ 46,62,67-69 ] and for OBPP [ 27,66 ] . In contrast, a high incidence of hasty 2nd phase of labour among babies with OBPP has besides been demonstrated [ 70 ] . However, Poggi et al suggest that although hasty 2nd phase is the most prevailing labour abnormalcy associated with shoulder dystocia, no feature of second-stage of labour predicts lasting brachial rete hurt [ 37 ] . Operative vaginal bringing is another hazard factor for shoulder dystocia and OBPP [ 3,21,22,26,27,68,71,72 ] . In Nesbitt ‘s survey the hazard of shoulder dystocia for operative vaginal bringings to diabetic female parents was 12.2 % for babies 4000-4250g, 16.7 % for those 4250-4500g, 27.3 % for those 4500-4750g, and 34.8 % for those 4750-5000g ( Nesbitt et al. 1998 ) . Cesarean subdivision decreases the hazard, but OBPP may still happen accounting for merely 1-4 % of all instances [ 22 ] [ 73 ] . When looking at combinations of hazard factors including manner of bringing, maternal diabetes and foetal macrosomia [ 22 ] , the incidence of OBPP appears similar in aided vaginal bringings of nondiabetic adult females and self-generated vaginal bringings in diabetic adult females. The combination of maternal diabetes, foetal macrosomia ( & gt ; 4500g ) and assisted vaginal bringing has the highest OBPP rate ( 7.8 % ) . Gilbert et Als have besides shown stronger associations between shoulder dystocia and brachial rete hurt with increasing birth weights. Twenty two per cent of neonates weighing 2.5-3.5kg with OBPP besides had shoulder dystocia, which increases to 74 % in newborns weighing more than 4.5kg. Overall, 53 % of brachial plexus hurt instances were associated with shoulder dystocia. The frequence of diagnosing of other malpresentation was increased ( OR 73.6, 95 % CI 66, 83 ) in this survey. This determination, harmonizing to the writers, suggests that â€Å" brachial rete hurt has other causes in add-on to shoulder dystocia and might ensue from an abnormalcy during the antepartum or intrapartum period † [ 22 ] . A old gestation complicated with OBPP is another hazard factor [ 74 ] . Al-Qattan and al-Kharfy [ 74 ] reported a high return rate in adult females with history of old childbearing with lasting OBPP and advocated elected cesarean bringing in these instances particularly if there is besides foetal macrosomia. However it is non known whether these consequences would use to instances of old impermanent OBPP. Gordon et al [ 6 ] besides found that 14 % of their 59 topics with OBPP were born to female parents who had given birth to babes with OBPP in old gestations.PathogenesisOBPP has been considered as a effect of inordinate grip and sidelong extension exerted on the foetal cervix during bringing, which consequences in stretching, rupturing or avulsing the cervical nervus roots from the spinal cord [ 75 ] . However, OBPP may happen in the absence of any grip or any identifiable hazard factors. During labour, the brachial rete is exposed to two potentially harmful forces: the endogenous ( intrauterine ) forces and exogenic ( grip ) forces applied by the clinician. Mathematical theoretical accounts, manikins and computing machine simulations have been used to quantify the forces applied on the brachial rete and the threshold for doing hurt. Although these surveies attempted to objectively quantify the grade of both endogenous and exogenic forces, their consequences should be interpreted with cautiousness due to their experimental nature. Exogenous ( grip ) forces If the foetal shoulders remain in a relentless anteroposterior place at the pelvic recess, as observed in instances of foetal macrosomia with an increased bisacromial diameter ( e.g. , with maternal diabetes mellitus ) [ 76,77 ] or precipitate 2nd phase of labour [ 54,70 ] the anterior shoulder may go wedged behind the symphysis pubic bone and farther descent of the foetal caput consequences in stretching of the anterior brachial rete. In shoulder dystocia the applied force and the clip to present the foetal shoulders is frequently significantly increased. Forceful downward grip of the caput when the shoulder is impacted under the symphysis pubic bone can potentially ensue in farther impaction and cause overstretching and hurt of the brachial rete. Downward grip of the foetal caput appears strongly associated with OBPP ( OR: 15.2, 95 % C.I. : 8.4-27.7 ) and the hazard is significantly increased with the grip force applied. Rotation of the shoulders into oblique pelvic diameter is bes ides associated with hazard of OBPP ( OR: 5.5, C.I. :1.6-18.9 ) [ 30 ] . Gonik et al [ 88 ] , showed that downward sidelong flexure of the foetal caput was associated with a 30 % addition in brachial rete stretch ( 18.2 % ) compared with axial placement of the caput ( 14 % ) . Furthermore, the foetal caput is in an unnaturally distorted place in relation to the shoulders, as the shoulders remain in the AP diameter at the recess while the caput has rotated in the AP diameter at the mercantile establishment { Sandmire, 2009 # 6162 } . The badness of the hurt may depend on the grade of grip, writhing and extension of the foetal caput { Sandmire, 2008 # 6057 } . The usage of force feeling devices has shown that the applied extremum grip forces are about 47 N for everyday bringings, 69 N for hard bringings, and 100 N for bringings complicated by shoulder dystocia, proposing that, as the badness of dystocia additions, stronger grip is normally observed [ 86 ] . Even in bringings non complicated by shoulder dystocia the forces applied during downward grip can be frequently underestimated as significant forces were found to hold been used in many OBPP instances [ 30 ] . Direct compaction of the symphysis pubic bone against the brachial rete may besides be a conducive factor to injury [ 13 ] . OBPP may happen regardless of the figure and type of manoeuvres used in instances of shoulder dystocia [ 12,14,69 ] , but the trouble to accomplish bringing of the shoulders and the demand for extra manoeuvres is correlated to the hazard of OBPP. Experimental surveies utilizing pelvic and foetal theoretical accounts, tactile feeling baseball mitts and computerised informations acquisition systems have besides shown that as the trouble of the bringing increases with increasing grip forces, there is a concentration of force on the brachial rete from exogenously applied sidelong flexure [ 87 ] . In these experiments it was demonstrated that the wider the foetal shoulder girth, the greater the force demands and the higher the incidence of hurt. In contrast, the McRoberts manoeuvre appeared to cut down the grade of brachial rete stretching. Slightly more than 10 % of the shoulder dystocia instances that resolve with the McRoberts ‘ manoeuvre entirely have brachial plexus hurt [ 78 ] . After an unsuccessful McRoberts ‘ manoeuvre, brachial plexus hurt rates range from 15.7 % if bringing is achieved by the Woods ‘ manoeuvre to 31.8 % if bringing of the posterior arm is undertaken [ 14 ] . Intrauterine causes As several instances of OBPP occur in the absence of grip or any known hazard factors, hurts to the brachial rete may be caused by the normal forces of labour and bringing. In one of the first surveies proposing that OBPPs are non needfully caused by clinician-applied grip, it was estimated that 26 out of the 51 OBPP instances were non associated with a bringing complicated by shoulder dystocia. { Gordon, 1973 # 615 } . Since so, several other surveies have shown that about half of all OBPPs are non associated with shoulder dystocia [ 5,12,13,18,19 ] and many instances have non been preceded by a hard bringing or grip on the anterior shoulder [ 20,79,80 ] . Harmonizing to different series, up to 20 % of lasting OBPPs are non associated with shoulder dystocia { Chauhan, 2005 # 48 } { Sandmire, 2009 # 6162 } . Jennett et al [ 18 ] concluded that brachial plexus hurt might be the consequence of intrauterine maladaptation and should non be needfully considered as leading facie grounds of birth procedure hurt. In the absence of shoulder dystocia, OBPP occurs by a different mechanism [ 81 ] . The bulk of OBPPs in the absence of shoulder dystocia ( 67.7 % ) appear to impact the posterior arm [ 59,84 ] . OBPPs of the posterior arm ( 39 % of all OBPPs { Gherman, 1998 # 114 } ) or after cesarean bringing suggest an intrauterine cause [ 3,4,18,19,27,38,82,83 ] . Brachial plexus stretching may be caused by an wedged posterior shoulder on the sacral headland while the propulsive forces of labour cause farther descent of the foetus { Sandmire, 2002 # 79 } . OBPPs may besides be secondary to compaction of the brachial rete on the sacral headland. Sandmire and DeMott { Sandmire, 2009 # 6162 } back up the impression that after the caput is delivered, the posterior shoulder can non be obstructed as the distance from the headland to the vaginal mercantile establishment ( 12-13 centimeter ) is excessively long to allow obstructor of the posterior shoulder and the foetal cervix can non be stretched that f ar { Sandmire, 2002 # 79 } , It is hence of paramount importance to document the place of the caput and shoulders in a instance of shoulder dystocia, as this type of hurt caused by impaction of the posterior shoulder on the sacral headland is unrelated to any action of the clinician and should non be considered negligent. Mathematical theoretical accounts have been used to gauge the exogenic and endogenous forces on the brachial rete during shoulder dystocia [ 89 ] . The endogenous forces were estimated to be 4 to 9 times higher than the clinician-applied forces ( 91.1 to 202.5 kPa vs 22.9 kPa ) proposing that self-generated endogenous forces may lend well to OBPP. However the writers of this survey acknowledged that their theoretical account did non account for a figure of confusing factors including soft tissue opposition, the dissipation of force throughout the womb or the compound consequence of grip and compaction forces. Further unfavorable judgment on this theoretical account focused on the gross premises made for the impaction site, the parametric quantities specifying the endogenous force distribution and the broad scope of contact force per unit areas between the foetal cervix and the symphysis pubic bone, which includes values that in existent life would transcend the fatal bounds [ 90 ] . Harmonizing to a little series, all of the 6 OBPPs following atraumatic cesarean subdivision had relentless hurt after a twelvemonth [ 85 ] . Brachial rete hurts have occured even when cesarean bringing was performed in early labour [ 82,85 ] . Uterine anomalousnesss, such as a lower uterine section fibroid or an intrauterine septum, may ensue in unnatural intrauterine force per unit areas and hurt to the brachial rete [ 85 ] . OBPP and phrenic nervus paralysis associated with a bicornuate womb have besides been reported [ 80 ] . Allen et Al, utilizing delivering simulators found that greatest stretch occurred in the posterior brachial rete during descent in non-shoulder dystocia bringings, whereas anterior brachial rete stretch, rotary motion, and extension were similar among non-shoulder dystocia, one-sided and bilateral shoulder dystocia bringings. The writers concluded that shoulder dystocia per Se does non present extra hazard of brachial rete stretch over everyday bringings [ 91 ] . However, they admitted that they did non command for loss of musculus tone secondary to hypoxia, the simulations were undertaken merely in occiput anterior place and the continuance of the 2nd phase in their experiment was less than 2 proceedingss. Although these experiments have improved our cognition on the mechanisms of hurt, clinical verification of their consequences is virtually impossible due to the emergent nature of shoulder dystocia and methodological and ethical issues around clinical research on the foetus during labour.Prediction and PreventionOur ability to foretell OBPP is rather limited as the bulk of the affected babies have no identifiable hazard factors [ 67 ] . In a series of 63 OBPPS most of the patients were nondiabetic ( 89 % ) , nonobese ( 76 % ) , had normal labour ( 91 % ) , and did non hold an assisted bringing ( 79 % ) . No hazard factors were identified in about 30 % of OBPP instances in another survey by Peleg et al [ 27 ] . Multiple logistic arrested development analysis utilizing prenatal, intrapartum, and neonatal factors predicted merely 19 % of the brachial rete hurts in the series of Perlow et Al [ 54 ] . Donnelly et Als have besides concluded that OBPP is non predictable by hazard factor hit ing or analysis of the partogram [ 63 ] . Shoulder dystocia, a major hazard factor for OBPP is mostly unpredictable. Statistical theoretical accounts have been developed to gauge this hazard utilizing combinations of birth weight, maternal tallness and weight, gestational age and para [ 92,93 ] . The presence of multiple hazard factors appears to be a forecaster for shoulder dystocia [ 94 ] . Designation of hazard factors and an prenatal direction with tight control of glucose degrees in pregnant adult females with diabetes may cut down the incidence of foetal macrosomia and shoulder dystocia. A program for bringing in high hazard instances should include a multidisciplinary squad attack with a senior accoucheuse or an experient obstetrician available at the 2nd phase. Initiation of labour Initiation of labour has been antecedently recommended in instances of suspected macrosomia, in order to cut down the hazard of shoulder dystocia and birth hurt, nevertheless, a Cochrane reappraisal showed that initiation of labour for nondiabetic adult females with suspected foetal macrosomia does non look to cut down the hazards of maternal or neonatal morbidity [ 95 ] . Cesarean Section The hazard of brachial plexus hurt is lower in cesarean bringings [ 3,96 ] . If identifiable hazard factors are present, an elected cesarean delivery bringing might forestall OBPP. Yeo et al suggested that bringings by elected cesarean subdivision for birthweights in surplus of 4kg would forestall 44 % of shoulder dystocias and halve the perinatal mortality among births with shoulder dystocia with a 2 % subsequent addition of the cesarean subdivision rate [ 97 ] . On the other manus, Gilbert et Al found that 92 % of the high hazard patients ( diabetic adult females delivered by operative vaginal bringing with babies of & gt ; 4.5kg birthweight ) did non hold OBPP and cesarean bringing would hold been unneeded [ 22 ] . Although macrosomia is normally associated with OBPP, Rouse et Al [ 32 ] found no benefit to elected cesarean bringing in adult females with estimated foetal weights of & gt ; 4.5 kilogram, unless they were besides diabetic. These writers estimated that when elected ces arean bringing was performed for estimated foetal weights of a†°?4.5kg, 3695 cesarean delivery bringings would be required for the bar of one permanent OBPP, whereas a policy of elected cesarean delivery bringings for birthweights of a†°?4kg was associated with 2345 several cesarean bringings. For diabetic adult females, more favorable ratios for cesarian bringings were estimated: 443 bringings with the 4.5kg policy, and 489 bringings with the 4kg policy. Ecker et al [ 38 ] besides suggested that at most birth weights, the figure of cesarean bringings necessary to forestall a individual hurt is high. In this survey, it was estimated that in nondiabetic adult females, between 19 and 162 cesarean subdivisions would hold been necessary to forestall a individual brachial rete hurt and among diabetic adult females between 5 and 48 extra cesarean delivery subdivisions would hold been required. The writers could hence non recommend the everyday usage of cesarean bringing in insta nces of macrosomia. The Royal College of Obstetricians and Gynaecologists recommends that elected cesarean subdivision can be considered in diabetic adult females when the estimated foetal weight is & gt ; 4.5kg and in nondiabetic adult females when the estimated foetal weight is & gt ; 5kg [ 98 ] . Nonetheless, some writers advocate a policy of offering elected cesarean bringing to adult females with kids with lasting OBPP [ 22 ] . Maneuvers at bringing For the bar of shoulder dystocia, contraceptive manoeuvres at bringing ( McRobert ‘s manoeuvre and suprapubic force per unit area ) have been evaluated, but there is deficiency of clear grounds to back up their modus operandi usage [ 99 ] . Management of shoulder dystocia The purpose of direction should be bar of foetal asphyxia, while avoiding foetal and maternal hurt. The go toing accoucheuse or obstetrician should be able to acknowledge a shoulder dystocia instantly and continue through a bit-by-bit sequence of manoeuvres to hasten bringing. Knowledge of the constructs that underlie manoeuvres and the practical inside informations of their executing appears much more effectual than cognition of the precise definitions or eponyms of each manoeuvre ( Crofts et al. 2008 ) . First line manoeuvres Mc Roberts manoeuvre involves acute flexure of the hips while the adult female is on supine place. This place straightens the lumbosacral angle, leting descent of the posterior shoulder. The maternal pelvic girdle is perpendicular to the way of the maternal expulsive forces. Gonik et al [ 88 ] , utilizing computing machine silent person theoretical accounts showed that with lithotomy placement, both endogenous and exogenic bringing forces were associated with brachial rete stretching during shoulder dystocia ( the per centum of brachial rete nervus stretch was 15.7 % vs 14.0 % , severally ) . McRoberts positioning resulted in 53 % less brachial rete stretch ( 6.6 % ) . Directed suprapubic force per unit area can be uninterrupted or ‘rocking ‘ force per unit area on the posterior facet of the anterior shoulder which may ease adduction of the shoulders, a decrease of the bisacromial diameter and rotary motion to an oblique place. Second line manoeuvres Delivery of the posterior arm is undertaken by infixing the manus in the vagina posteriorly and using soft force per unit area at the antecubital pit to flex the foetal forearm, which is so grasped and swept across the foetal thorax. If bringing of the posterior arm is achieved, the anterior arm rotates posteriorly or descends behind the symphysis pubic bone as Kung et Al showed that the shoulder dimensions are reduced by 2.5cms with this manoeuvre particularly in larger foetuss ( Kung et al. 2006 ) . Rubin ‘s manoeuvre: rotary motion of the shoulders is attempted by insertiong two fingers in the vagina behind the anterior shoulder. The shoulder is pushed frontward and the bisacromial diameter rotates into an oblique place. If unsuccessful, this can so be combined with the Woods ‘ prison guard manoeuvre. Forests ‘ prison guard: force per unit area is applied with two fingers on the anterior facet of the posterior shoulder and use force per unit area taking to revolve the foetus towards the same way as the Rubin manoeuvre. Reverse Woods ‘ prison guard: with two fingers behind the posterior shoulder rotary motion is attempted in the opposite way to the original Woods ‘ prison guard. All these manoeuvres aim to revolve the shoulders and enable bringing by conveying the anterior shoulder posteriorly. Interpolation of the whole manus in the vagina may enable better push on the shoulder and facilitate rotary motion ( Crofts et al. 2008 ) . All-fours: the adult female is on her custodies and articulatio genuss and soft grip is applied taking to present the buttocks shoulder which may fall due to gravitation and to a possible addition of the anteroposterior diameter of the maternal pelvic girdle. Clavicular break: although the bisacromial diameter is reduced with this manoeuvre, there is an increased hazard of iatrogenic brachial rete hurt, vascular and soft tissue foetal injury. Third line manoeuvres Zavanelli manoeuvre involves flexure of the foetal caput, reversal of damages, rotary motion of the caput back to the occipito-anterior place, and replacing into the womb. Tocolytics and general anesthetic agents are used for uterine relaxation. The foetus is so delivered by cesarean subdivision. Although this manoeuvre has success rates of up to 92 % , it is associated with terrible fetal and maternal morbidity including foetal hurts and deceases, uterine and vaginal rupture. Symphysiotomy requires surgical expertness and is associated with important hazards of lower urinary tract hurt. The patient is on a supine place and the thighs are abducted no more than 45IS from the midplane. A urethral catheter is inserted and the urethra is displaced laterally. Following local infiltration with lignocaine, a perpendicular pang scratch is made on the symphysis with a scalpel. The symphysis is normally partly separated by cutting through the fibers by rotational motion of the blade. This allows the anterior foetal shoulder to be disimpacted. In instances of shoulder dystocia, the hazards of OBPP may be reduced if manoeuvres are conducted suitably and forceful downward grip of the caput is avoided ( figure 1 ) . Gonik et al [ 88 ] , showed that downward sidelong flexure of the foetal caput was associated with a 30 % addition in brachial rete stretch ( 18.2 % ) compared with axial placement of the caput ( 14 % ) . Fundal force per unit area should be avoided as it can decline shoulder dystocia and grip combined with fundal force per unit area can be associated with neurological complications [ 57 ] . Consequences may be better and hazards of OBPP lower if there is no terror, force per unit area on the fundus, sidelong grip or pivoting of the caput at the cervix and when tortuosity or rotational motion of the caput to revolve the shoulders is avoided { Doumouchtsis, 2009 # 6174 } .DecisionOBPP is a potentially annihilating complication of childbearing. Shoulder dystocia is merely one of a battalion of hazard factors for OBPP, most of which may be hard to foretell. Future research should be directed in prospective rating of the mechanisms of hurt, in order to enable accoucheurs, accoucheuses and other wellness attention professionals identify modifiable hazard factors, develop preventative schemes and better perinatal results.

Friendship: Interpersonal Relationship and Friendships

Friends and Friendships in Emerging Adulthood Carolyn Manager Barry* Loyola University Maryland Stephanie D. Madsen McDaniel College â€Å"I'll be there for you, when the rain starts to pour. â€Å"l These lyrics began each episode of the popular sitcom Friends. The trials and tribulations of these six â€Å"20-something† friends captivated the American public for a decade until Ross, Monica, Joey, Phoebe, Chandler, and Rachel eventually transitioned to adulthood at the shows closure.Perhaps the shows popularity was due to having some truth in the fiction: (a) friends can be a proxy family for young people, offering invaluable advice, support, and musicianship; (b) friends can be of the same or opposite sex, but these two types of friendship work differently; (c) friends may engage in casual sex, but may also become involved romantically; (d) friendships are central to the lives of emerging adults, especially those who are single and not in a serious romantic relationship; a nd (e) friends help people to figure themselves out and influence their behavior, potentially for both good and bad.As is the case with all TV shows, there is also pure fiction in this sitcom: these six friends lived in the same apartments in the same city ND often held down the same Job for over a decade. Instead, instability is more the norm among realize emerging adults. Also, most American young people get married and become parent's in their late ass rather than the ass (as the sitcom depicted). So while close friendships are critical to emerging adults' happiness, search for their identities, and true loves, friends become less important once they've figured out the big questions of life and â€Å"settle down† in marriage, parenthood, and careers.Still, for emerging adults, friends can fill the growing gap between the time when they leave he families they grew * Carolyn Manager Barry is an associate professor of psychology at Loyola University Maryland. Stephanie Madsen is an associate professor of psychology at McDaniel College. 2 Changing Spirituality of Emerging Adults up in and when they establish families of their own. Can Men and Women Be Friends? With persons of the same or opposite sex. Children need same-sex friendships in order to develop into socially skilled, moral, and empathetic adults.From the teen years on, it is common to make friends with both sexes, and these friendships can be f good quality, as seen in Rachel and Joeys friendship?they regularly shared problems, offered support, and simply enjoyed each other's company. Still, people most prefer same-sex friendships throughout their lives, and it is less common for men and women to be friends beyond college or after one friend marries. Friendships between men and women differ in some ways from those between people of the same sex. Men's friendships with women are more emotionally intimate than their friendships with men.And heterosexual men often seek friendships with women to w hom they are sexually attracted. Not surprisingly then, approximately Alfa of opposite-sex friends in college report that they have engaged in sexual behavior, which has the potential to hurt the relationship. However, many college students believe that sex enhances a friendship's quality and helps them to consider whether they want to remain â€Å"Just friends† or move on to something more. What Are Friendships Like? There appears to be some truth to the old adage â€Å"birds of a feather flock together. Certainly we saw this portrayed in the six characters on Friends. All shared the same ethnicity (European American), enjoyed the same activities (sipping coffee at Central Perk), and had similar levels of social skills (though Joey seemed more adept at getting dates than Ross or Chandler). Such similarities offer a common ground that strengthens friendships and helps them to endure. Women's friendships are often communal?offering companionship, intimacy, emotional security, and affection. Friends Rachel and Monica supported each other with late-night chats.Men's friendships emphasize competition and are more gigantic? providing help, a reliable alliance, and self-validation. Friends Joey and Chandler 3 competed in videotapes from matching recliners. Still, men and women value friendships with all of these features (perhaps placing greater importance on the communal). From the teen years on, intimacy becomes the hallmark of friendships and is related to how close we feel toward our friends. Emerging adults' friendships are even more emotionally intimate than their friendships of Just a few years earlier. Relationship quality depends not only on what you give friends, but also what you get.In addition to the healthy dimensions we described above, friendships can also have negative aspects, such as frequent conflict, power inequities, and antagonism. Women's friendships, in particular, can fall prey to co-rumination, where women obsess over problems in t heir lives in conversations with friends instead of taking fruitful action. In one episode of Friends, Chandler sought support from the girls following a break-up; they urged him to talk about his feelings (adding, â€Å"if you want to lead to depression. Thankfully, positive friendship qualities can help buffer negative ones.Friends focused on one particular cultural and ethnic group. Likewise, current research on emerging-adult friendships largely ignores cultural influences on friendships, though important differences exist. For example, different ethnic groups seek different friendship qualities. Asian Americans emphasize an amicable exchange of ideas, African Americans seek acceptance and respect, Latino Americans highlight the importance of relational support, and European Americans focus on meeting individual needs of each friend. How Do Friendships Change across Emerging Adulthood?Given the many transitions that emerging adults face, it is not surprising that their friendsh ips change as well. Transformations in friendships and friendship networks relate to life stage rather than age. So knowing that a person is 20 versus 26 does not ell us much about their friendships. Instead, knowing whether they are romantically involved or have children is much more informative than age alone. Friends are frequent companions, getting together at least once a week for no specific purpose (for example, gathering at Central Perk Just to talk) and less frequently 4 for events such as movies, parties, and concerts.Friends find less time to get together as they progress toward adulthood. Despite these overall changes in approaches to friendship networks, emerging adults keep their individual patterns of interacting with friends. So a very social or very shy teen will adopt the same approach to friendship networks as an emerging adult. The small friendship network on Friends remained stable over 10 years?not at all typical of most emerging adults' networks. Instead, emer ging adults become increasingly flexible in whom they include in friendship networks and how they maintain these networks.They grow more accepting of opposite-sex friendships, even keeping former boyfriends or girlfriends on as friends. European American emerging adults' friendship networks become more diverse (especially if they are exposed to more diverse social networks through allege or work), but the networks of African American, Latino American, and Asian American emerging adults become less diverse (especially if they invest in activities and groups linked to their ethnicity). Relative to the rest of the lifespan, friendship networks are the largest during early emerging adulthood and get smaller later on in emerging adulthood.Although women have more close friends than do men on average, men's and women's friendship networks are of equal size. Still, the friendship network on Friends did illustrate the density that is typical of emerging adults' friends. It is common for man y network members to share common links (working at the same place, living in the same building) or even to be friends with each other. People tend to form relationships with others in their same social situation. True to life, the characters in Friends shared roughly the same place in life when their group formed.They were single, had no or few childcare responsibilities, and were still searching for meaningful careers. More on the side of fiction, the friendship network of these television friends did not change in response to their own life changes, as is happily. Friends seldom featured the workplace, but many emerging adults find friends there as they explore career pathways and settle into adult work roles. Career stage influences the lives of single emerging-adult men, especially.These men often have large 5 friendship networks preparer, but have few friends who provide emotional or instrumental support; the time constraints inherent in beginning a career bring friendship net works down to a more manageable size. Career transitions don't seem to alter single women's friendship networks in the same way?women maintain ironsides networks during their careers that are similar in size to those they had while in their late teens and early ass. The characters on Friends had many romantic involvements, and whether emerging adults are single, dating, or married affects friendship networks.Single and dating people are strongly attached to friends, naming friends as their top companions and confidants. In contrast, romantically involved emerging adults change the time they spend with friends. Early in their relationships, emerging-adult couples spend more time with friends to introduce them to their new romantic interest. But as the relationship gets serious, the couple withdraws from the circle of friends. This was shown in the final season of Friends. By then Monica and Chandler had hooked up, fallen in love, and gotten married.When the group of friends gathered to celebrate Earache's daughter's first birthday, Monica and Chandler instead opted to sneak away for a romantic weekend alone. Typically, withdrawal is selective, with couples spending less time with peripheral friends and more time with friends who support their relationship. A few Friends characters became parent's, an event that typically happens at the end of?or even after?emerging adulthood. Although their tight friendship network remained stable, parenthood normally reorganizes friendship networks.New parent's report fewer friends following the birth of a child, and fathers, especially, report less satisfying and supportive friendships than they experienced beforehand. Family members generally do not try (and in truth feel that they should not try) to influence who emerging adults' friends are or what they do with these friends. And friendships don't often influence family relationships. Instead, some emerging adults view their friends as â€Å"being† family. Sexual-mi nority emerging adults whose families reject them sometimes adopt a family of choice from a network of supportive friends.Other emerging adults do this too, as shown when Friends characters spent Thanksgiving together instead of Joining their families. Likewise, it is common to hear emerging 6 emerging adults sometimes consider family members (especially siblings or cousins) to be friends. For example, Ross and Monica were siblings who offered each other companionship and emotional intimacy. Finding close ties among family members provides a ready source of support, but being more involved with peers helps merging adults weather some transitions better (for example, moving away from home).Friends and friendship networks also influence romantic relationships. For example, emerging adults often find new romantic partners within their existing friendship networks. This meaner that the diversity found within an emerging adult's friendship network influences the likelihood that he or she will date someone of a different race. Friends complain loudly when too much time is spent with a romantic partner (but they are likely to support the romantic relationship if they know the boyfriend or girlfriend well).Friends' support (or lack of support) for a romantic relationship affects the couple's level of commitment to the relationship. Perhaps knowing this, emerging adults are sometimes selective about the friends to whom they introduce a new romantic partner. Friends can influence break-ups, but they do so infrequently. Couples don't stay together for the sake of their friends, even though there can be a high cost to breaking up with a romantic partner when they share the same friends. For example, throughout the series, Ross and Rachel had an on-again, off-again relationship.Each time they broke up, it disrupted their friendship network. Why Do Friendships Matter to Emerging Adults? From toddlers to old age, we have friends. But why are they so important in the lives of emerging adults? First, friends support emerging adults' identity development. Friendships provide feelings of worth as well as opportunities for story telling and frank discussions about religion, life aspirations, moral dilemmas, and relationships. Certainly, friends' banter at Central Perk not only rehashed the weeks events, but also tried to make sense of the world around them.The intimacy forged wrought these heartfelt discussions not only helps with finding oneself, but also nurtures close friendships. Second, friendships contribute to how emerging adults feel about themselves; feeling good (or bad) about your friendships coincides with feeling good (or bad) about 7 yourself. Emerging adults who rarely spend time with their friends are lonely. But spending time with friends who validate their feelings brings happiness (perhaps this explains why Joey was perpetually happy, despite not having much success as a which are useful during the many?and at times anxiety-inducing?trans itions that merging adults face.Third, friendships support emerging adults' understandings of how relationships work, and, in fact, many discussions center on these ties. Friendships provide occasions to see things from someone else's point of view. This, in turn, helps emerging adults to think through issues more critically and carefully. Fourth, friendships offer companionship?both in person and from afar?during what can be a lonely time. Over the past decade, emerging adults have increasingly relied upon cell phones, testing, instant messaging, and social networking sites like Faceable to communicate with friends.Online friendships can be good ones, especially when they last long enough to develop into emotionally close and supportive relationships that supplement existing friendships. On the other hand, having 800 â€Å"online friends† is not equivalent to having friends you see regularly. In the coming years, maybe we'll know what benefits online-only friendships serve a nd when it is that technologies improve?rather than undermine?friendships. For now it is safe to say that most emerging adults use technology to enhance existing friendships rather than to replace them.Lastly, friendships involve intimacy and interdependence, and the development of these skills supports ongoing and future romantic relationships. Same-sex friends regularly discuss their romantic relationships?especially problems. Given that men find the most intimacy in their friendships with women, these friendships probably help them to develop emotional intimacy skills they'll need for other close relationships. Can Birds of a Feather Shape a Flock? Emerging adults report that friends affect their major life decisions.In fact, friends' behaviors affect emerging adults' positive outcomes, including church attendance. Friends' behaviors also influence more negative outcomes (e. . , those with aggressive 8 friends are more likely to abuse their romantic partners). Besides friends' be havior, the quality of the friendship matters, with â€Å"better† friendships promoting positive adjustment and reducing problem behaviors. We don't yet know whether these effects are due to choosing a bird with similar feathers or birds shaping each other's behavior? likely it is a bit of both. What Does Friends Teach Us about Friends?Friends went off the air in 2005, but through DVD releases and syndication it continues to illustrate core concepts about emerging-adult friendships today. This show offers key implications for practitioners working with actual 20-something friends. 1 . Friendships are important in emerging adulthood, but their importance changes as romantic relationships become more salient and stable. Amid emerging- adults' numerous transitions, practitioners should ask troubled young people about and (mostly) platonic opposite-sex friendships, in reality these are less common than same-sex ones.As seen in Ross and Earache's relationship, the line between a f riend and a romantic/sexual partner is often fuzzy, creating feelings of anticipation and disappointment. Practitioners should be careful not to assume that opposite-sex friendships among heterosexuals are platonic or romantic. 3. Practitioners should strive to create environments that support friendships with diverse peoples. For many young people, moving out on their own provides their first exposure to individuals with substantially different backgrounds and ideas from their own. Interactions with these individuals can support growing maturity. . Friends are influential for better and for worse. Helping emerging adults form friendships with people who show positive behaviors (e. G. Ammonia's career success) will, in turn, promote successful development. Likewise, emerging adults whose friends are making poor life decisions may find it helpful to distance themselves from these friends and align themselves with other friends who are making better decisions. 9 5. Friendships are par ticularly important for marginalia peoples (ethnic or sexual minorities), and efforts to form friendships with allies and similar others will serve these young people well.For some, friendship and family networks overlap. Friends may be close enough to be considered â€Å"family'; likewise, some emerging adults insider family members to fulfill friendship needs as well, as Monica and Ross clearly did. 6. Although Friends' characters were limited to cell phone use, modern- day emerging adults are as'. N. Y with technologies such as testing and social networking sites to support existing friendships rather than supplant them. This appears to be a positive dimension of friendships that makes sense given that they are always on the move.But practitioners should encourage face-to-face interactions, particularly for very personal and life-transforming discussions?not all of life's battles can be won or lost via Faceable. . Emerging adults weather transitions best when they maintain exist ing friendships but are open to forming new friendships. For example, upon moving to the city, Rachel rekindled her old friendship with Monica but established new friendships with the other four. This may be challenging for some emerging adults who prefer to stick close to family, but making friends in new settings benefits them in the long run.Throughout our whole lives?but especially in emerging adulthood, it seems?we need friends who will â€Å"be there† for Notes The Rembrandt (1995), â€Å"I'll Be There for You,† Atlantic Records. Episode 14; â€Å"The One with the Cake,† season 10, episode 4; â€Å"The One with All the Thanksgivings,† season 5, episode 8; â€Å"The Pilot† (â€Å"The One Where Monica Gets a Roommate†), season 1, episode 1 . 10 Annotated Bibliography Fall, W. A. , and Faulkner, S. L. (2000). On being â€Å"Just friends†: The frequency and impact of sexual activity in cross-sex friendships. Journal of Social and Pe rsonal Relationships, 17, 205-222.Can women and men be â€Å"Just friends†? These authors sampled American university students and found that some emerging adults can have platonic friendships with the opposite sex. However, approximately half of heterosexual college students have had sex with opposite-sex friends. Among those who added â€Å"benefits† to their friendships, some did so frequently and others only every few years. The overwhelming majority of these friends were single when sexual encounters occurred, but a third of these friendships included at least one romantically involved friend.Having sex with a friend was relationship-enhancing in some cases and quite damaging in others. Allan, G. (2008). Flexibility, friendship, and family. Personal Relationships, 15, 1-16. In a comprehensive and current overview of reindeer's (including friendships in emerging adulthood), this author highlights instances where friendship and family overlap, support each other, an d are in conflict with each other. A sociologist, Dry. Allan especially focuses on societal changes over the past 40 years that have allowed people to enjoy greater freedom and flexibility in forming their own personal relationships.He reflects on suffusion in relationships (the merging family and friend relationships) but emphasizes that people have distinct understanding of these two types of relationships. Bagel, C. L. , Bender, S. E. Andresen's, C. L. , Kinshasa, T. L. , Monticello, S. A. , and Mueller, J. G. (2005). Friendship quality and perceived relationship changes predict psychosocial adjustment in early adulthood. Journal of Social and Personal Relationships, 22, 235- 254. 11 It seems that although friends agree about the quality of their relationship, each person has a slightly different view of the relationship.When friends disagreed about their relationship, they felt less satisfied about the friendship and were more hostile. So while having friendships with positive d imensions is important, noting the extent f negative dimensions in the relationship matters as well, particularly as it can shape an individual's well-being. Barry, C. M. , Madsen, S. D. , Nelson, L. J. , Carroll,J. S. , adulthood: Differential associations with identity development and achieved adulthood criteria. Journal of Adult Development, 16, 209-222. How do friendships change as emerging adults move toward adulthood?In a study of over 700 emerging adults, these authors found that people who were more â€Å"adulteries† actually had poorer quality friendships than did those who had not yet made adult commitments. In contrast, adulteries emerging adults had better romantic relationships. It seems that some of the steps toward becoming an adult (settling into a career, avoiding risky behavior, etc. ) might happen because of romantic partners more than because of friends. Boost, K. K. , Cox, M. J. , Brunching, M. R. , and Payne, C. (2002).Structural and supportive changes i n couples' family and friendship networks across the transition to parenthood. Journal of Marriage and Family, 64, 517-531. Having a baby changes everything?including friendship networks. These authors followed 137 couples from he time they were expecting to their children's second birthdays. Close friendships were especially important to new mothers over this time period, while their husbands' friendship networks declined and became less satisfying. For all parent's, having close friendships protected against feelings of depression during this transition.Crabber, J. , and Burgomaster, D. (1998). Friendship and need fulfillment during three phases of young adulthood. Journal of Social and Personal Relationships, 15, 393-409. 12 Changing Spirituality of Emerging Adults These scholars examined how friendship lays out in different phases of emerging adulthood defined by family roles rather than by age: the single phase, the meritorious-children phase, and the parenthood phase. Emerging adults rely on friends to meet social needs the most during the single phase, slowing down their reliance as they move to the married and parenthood phases.Women call on friends for emotional support more than men do across all three phases. Deck', E. L. , Laggardly, J. G. , Miller, A. C. , schemer, M. J. , and Ryan, R. M. (2006). On the benefits of giving as well as receiving autonomy support: Mutuality in close friendships. Personality and Social Psychology Bulletin, 32, 313-327. Is it better to give than to receive support? The originators of Self-Determination Theory (Decide and Ryan, 2000) showed that receiving support from authority figures makes a big difference in people's motivation and satisfaction.This study extends their findings to friendships, where each partner is equal in terms of their authority. Indeed, people benefit by giving and receiving autonomy support to/from their friends, but it is the giving of such support to a close friend that matters more to a person 's well-being. Admire, M. , Oxidize, M. , and Whitecap, L. A. (2007). Looking to happy tomorrows with friends: Best and close friendships as they predict happiness. Journal of Happiness Studies, 8, 243-271. While friendship and happiness seem like a natural fit, the story is more complicated.Do all friends make people happy? The scholars find that spending time with a best friend makes people happy, especially when they also spend time with a person's happiness. Female, D. H. (2001). No couple is an island: A social network perspective on dyadic stability. Social Forces, 79, 1259-1287. How do friends affect emerging adults' romantic relationships? Interestingly, this study finds that thinking hat friends support a romantic relationship matters more 13 than how much they actually support it.These perceptions of support from friends lead to more stable relationships, but at the same time, having a really close best friendship makes it less likely that a romantic relationship will endu re (perhaps because the friendship competes with the romantic partnership for one's time). It seems that friendships can have both positive and negative effects on emerging adults' romantic relationships. Grief, G. L. (2009). Buddy system: Understanding male friendships. New York: Oxford University Press. Considerable emphasis has been given to women's friendships with their hallmark high levels of emotional intimacy.The author levels the playing field in this book by summarizing extensive interviews with 400 men to describe what makes their friendships tick, affirming the importance of friendships for the well-being of men and communities. Additional interviews with women allow for appropriate contrast between the two genders. The author presents a typology of different kinds of male friendships: must (friends with whom it is critical to share important news), trust (highly liked friends, but not as useful as a must reined), Just (acquaintances who are companions), and rust friends (long-time friends).Lastly, characteristics of male friendships from early to late adulthood are described and interwoven with meaningful life events that shape these close relationships. Hearth, W. W. , and Stevens, N. (1997). Friendships and adaptation in the life course. Psychological Bulletin, 121, 355-370. These scholars show that friendships add considerable value throughout the lifespan. People's expectations and descriptions of their friends change throughout life, which makes sense given that people's thinking becomes more sophisticated. Regardless of these changes, people of all ages agree that friendships should involve both give and take.How friends engage with one another does change with age and situation. While having friends generally is a good thing for people, it depends upon the identity of friends and the quality of these relationships. 14 Letterer, A. M. , Griffin, E. M. , and Sparks, G. G. (2007). Forecasting â€Å"friends forever†: A longitudinal inves tigation of sustained closeness between best friends. Personal Relationships, 14, 343-350. Following a cohort of university students from 1983 until 2002, these scholars examine which college friendship characteristics matter in

Ideology in Desperate Housewives

Ideology In Desperate Housewives Every day, the public is unknowingly exposed to countless ideological messages. They come from all around, but the media remains ideology’s primary agent. In places such as magazines, commercials, billboards, movies and television shows, one can find evidence of ideological messages. According to theologist Louis Althusser, ideology places individuals into a certain position in society by a process called interpellation, where a specific subject (or group of people) is called out, or hailed.Althusser claims that ideology does this in order to â€Å"help people to live their own conditions of existence, to perform their assigned tasks, but also to ‘bear’ their conditions. † An example of this can be found in television dramas aimed at American middle-aged women, as found on ABC or Lifetime. One potent example comes from the drama Desperate Housewives. This show may seem like a glorified soap opera, as it primarily depicts the lives of four dynamic homemakers living in the same cal-de-sac in suburbia.However, the show’s purpose is not solely to entertain, but also to hail its audience of middle-aged women by telling them what kind of behavior is acceptable for their role in society. In the episode â€Å"You Must Meet My Wife,† each housewife struggles with a personal conflict as their natural desires and tendencies conflict with the type of behavior expected of them as spouses and mothers. We see these discrepancies unfold as the characters are confronted by sexual temptation, marital infidelity, discontent with their husbands and gender roles regarding family finances.In the end, we will see ideological norms reinstated by these women resisting their true feelings in order to act â€Å"appropriately. † On the surface, Bree Van de Kamp looks like the ideal housewife. Her house is always spotless and she cooks gourmet delicacies for her family’s dinner every night. However, as the series progresses, we learn that there is a lot more to Bree (as there is to any person). In this episode, Bree is seduced by her much younger and very attractive contractor. Bree is single, so this is not a matter of infidelity, but of general sexual urges.The narrator explains that Bree was brought up traditionally, learning to hide and suppress her desires in order to be a â€Å"lady. † Therefore, Bree denies her urges because she recognizes that as a woman, society does not approve of her being sexually outgoing. This point is hit home when she fires her contractor so that she is not tempted by his company. She lies and tells him she is letting him go because he is doing a sloppy job, unable to admit to him (or anyone) that she is having fantasies about him.Bree’s display of â€Å"weakness† makes the plot relatable and entertaining to the audience, since it is made up primarily of middle-aged women who feel the same pressure to be almost inhuman sexually . Ironically, that pressure is being reinforced by the ideological lesson that this episode teaches. Gabrielle Solis profiles a different kind of housewife. Her conflict arises when a nurse informs her that her daughter’s blood type indicates that she could not possibly be the child of Gabby and her husband, Carlos.Gauging Gabby’s reaction, the nurse assumes that the child must not belong to Carlos, and judgmentally implies that Gabby was unfaithful. The nurses actions are direct proof of the ideological message: if a housewife cheats on her husband, she loses worth. Panicking, Gabby concludes that she must have cheated on Carlos during a weekend away with her girlfriends when she was blackout drunk. Several ideological violations arise here. First, her role as a housewife does not permit weekends away with her friends where she gets wildly intoxicated. Second, cheating on your husband is of the utmost offense.Although women now have equal rights to match their equal c apabilities, our society is still predominantly patriarchal. Gabby pays for her indiscretions in this episode. Scared and deeply ashamed, she must deal with her overwhelming guilt. Her struggle reinforces ideological norms, teaching her (and consequently, the audience) that she should have been home with her family rather than out for a fun weekend with her friends. It turns out to have been all a mistake, and Gabby was not unfaithful, however her ideological lesson was learned the hard way.Yet another ideological message is presented through the life of Lynette Scavo. Strong, smart and opinionated, Lynette is the feminist who equates to (if not exceeds) her husband in most areas. However, she is not immune to the ideological restraints of being a housewife either. In this episode, her husband Tom is diagnosed with Post Part-um Depression due to the recent birth of their daughter. There is a comical quality to this, as Post Part-um Depression is mostly known as a disease for women. This works to make Tom look weak, while Lynette is exhausted taking care of the house and the kids.She laughs at Tom’s diagnosis, and he becomes offended, stating that she is always too critical. Lynette’s friend Renee becomes involved, telling Lynette that she needs to â€Å"demonstrate her abilities as a wife† and make it up to Tom. Renee’s character provides insight to the ideological belief that wives should be supportive and nurturing towards their husbands, even if it means sacrificing their own comfort or opinions. In the end, Lynette apologizes and listens to Tom complain for hours, just as a proper housewife is expected to do.The domestic role of women is reinstated again through Susan Delfino’s storyline. Unlike Bree and Gabby, Susan lives more of a working class lifestyle, and recently work has been slow for her husband Mike. Tight on money, Susan decides to pick up another job to supplement her income as a teacher. She does this by agre eing to do housekeeping in lingerie for a live-feed stream on the internet. Although this side-job is harmless and proving to be quite profitable, ideology tells her (and consequently, the audience) that this job is something she should be ashamed of.She lies to Mike and tells him she’s been selling homemade jewelry (more of a â€Å"lady-like† hobby) for extra money. It might make sense if Susan felt ashamed because the job might be degrading the sanctity of her body, but that is not the reason. She lies to Mike because if he knew she was using her body to make extra money for them, he might be embarrassed, upset, or even angry. As the ideology of a housewife maintains, a husband should be the main source of finances and his wife should keep him comfortable and happy. Susan breaks these rules, and it burdens her with guilt throughout the episode.She should not be ashamed to be making money in a time where finances are low, but since society does not deem it appropriate , Susan sacrifices her good conscience to be a good housewife. In conclusion, Desperate Housewives reinforces ideological norms of middle-aged women through every main character in the show. The audience might think they are only being entertained for an hour, but what they take away from it is so much deeper. They are impressed with the ideology that women of a certain aged should act, talk, and feel this way. The audience learns lessons through the characters.This particular episode taught us that fulfilling your role as a housewife is of the utmost importance, even if it means sacrificing your natural desires, freedoms, opinions, or capabilities. Desperate Housewives is not the first television show to promote this ideology. Throughout history, the ideal housewife has been depicted as static, obedient, asexual, and sometimes seemingly inhuman. However, a show centered on such a character would be dull. So Desperate Housewives takes some liberties, letting the characters run rampa nt and make mistakes, only to recoil back into their rightful places inside of their homes on Wisteria Lane.

Annotated Bibliography Example | Topics and Well Written Essays - 250 words - 26

Annotated Bibliography Example Granić, A., & ĆukuÃ… ¡ić, M. (2011). Usability Testing and Expert Inspections Complemented by Educational Evaluation: A Case Study of an e-Learning Platform. Retrieved from http://www.ifets.info/journals/14_2/10.pdf. The article mentioned in above is an effective example of the study that has been conducted by using usability testing. It can be noted that the usage of the testing has been done for the purpose of analysis of educational programs. In particular, the application has been done in the context of Europe. The methodology that has been appointed by the authors in the research article is basically quantitative in nature. Credibility: The research mentioned in above is highly credible because the authors have presented pre-testing as well as the pro-evaluation to justify their stances and hypothesis. In this way, the readers will be able to read a thoroughly credited work. Granić, A., & ĆukuÃ… ¡ić, M. (2011). Usability Testing and Expert Inspections Complemented by Educational Evaluation: A Case Study of an e-Learning Platform. Retrieved from

Construction Safety Assignment Example | Topics and Well Written Essays - 250 words

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Culture and communication Essay Example | Topics and Well Written Essays - 250 words

Culture and communication - Essay Example Then I must make sure I view patients as individuals rather than members of a particular category. Considering the patient’s perspective in an empathic way is vital, especially when they make non-verbal expressions, which I must be careful not to miss or ignore. Lastly, forming a partnership with the patient will reassure them that we are working together towards one end, standing us together, rather than on either side of a gulf. This promotes trust and understanding. 2. First impressions last longest: Matthew said he hopes to improve his expression and tone to reflect a more caring attitude, seeking to comfort and soothe the patient. This is very good, because patients place a lot of trust and hope in a medical practitioner, so it should not be left to chance or personality. However, training in aspects of cultural competency, and in avoiding unconsciously categorizing patients (Medscape CME 2008), is something I must address as critical, in addition to appropriate bedside manner. A patient should feel on a level standing with all others, and feel that I can empathize and consider their individual circumstances and preferences. Experience will help me gauge facial and other non-verbal messages to accurately decipher a patient’s preference, fears, choices and inclinations. This means I must look inside myself and discover more about how I regard members of our culturally-diverse

Wal-Mart on Becoming the World's Largest Company Essay

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A Comparative Analysis of Early Childhood Curricula in England, New Essay

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The Explore Project Essay Example | Topics and Well Written Essays - 2000 words

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Online Shopping Essay Example | Topics and Well Written Essays - 1000 words

Online Shopping - Essay Example Though online shopping has some disadvantages it is better as compared to physical shopping. Time factor is the most important factor to consider when focusing on advantages of online shopping. It saves more time when doing online shopping than in the physical shopping. One can easily buy multiple of products in just a minute rather than spending more time moving to different shelves to look for products physically. An individuals needs to have an electronic gadget which can connect him or her to internet and access products over the net. One can use a computer or IPad or Smartphone to carry out the shopping. In doing the online shipping an individuals can click using the mouse, multiple products and make the payment at once. The time spend in carrying out shopping physically is more which can be used in other business. Time is money and with online shopping an individual can place order of many products in few seconds and carry out other important business. An individual also can search for the product he or she needs within the shortest time in different online sites. It is time saving to carry out online shopping and individual should consider buying things online in order to save time (Ships2door 2). The products are provided at lower price in online stores than the physical stores. The cost of storage and service providers salary is cut in online shopping and that is why many organizations offer products cheap than in stores. The online stores do not need the seller to pay for electricity, rent, cashiers and this reduces the cost of products. An individual can also buy products in a different country with good prices. The cost of transport is also saved when doing online shopping, an individual does not need to travel to the stores in order to get the product but he or she can make the shopping even at the bedroom. It is relatively cheap to make shopping online than shopping at the stores and

Terms Comparison Paper Essay Example for Free

Terms Comparison Paper Essay Within the world of health care economics, the United States â€Å"for-profit† health care system, strife with inflated costs and barriers to access, is in a process of reform. Rising insurance premiums, capitation, and market competition that discourage the consumption of unnecessary services currently reward providers for their focus on acute, episodic treatments, rather than encouraging improved health outcomes or disease prevention. The supplier-induced market has forced medical providers to base treatment recommendations on economic necessity. Complex billing and insurance operations have caused administrative costs to skyrocket. The Affordable Care Act (ACA) aims to correct these inefficiencies by reducing personal health care costs, improving community health, and increasing access to quality care. The following discussion will examine the interplay of capital resources, Meaningful Use, and financial incentives within the world of health care economics and system reform. Capital Resources Capital resources refer to assets used by a health care organization that facilitate the delivery of services. As the United States’ health care system evolves from an institution dependent on the acquisition of revenues from hospital admissions and procedures to one focused on managing health and wellness, the careful utilization and deployment of capital resources is critical to economic growth. Computer programs are a beneficial capital resource that supports the practice of medicine, such as computerized order entry or clinical decision support systems. For example, a computerized order entry system reduces the duplication of diagnostic testing while clinical decision support systems help providers manage chronic conditions. Industry experts agree the adoption of health care information technology (HIT) is necessary for improving quality and efficiency, although, as of 2006, only 12% of physicians and 11% of hospitals invested in technological improvements to their capital resources (Congress, 2008). Meaningful Use Meaningful Use refers to standards of quality demonstrated when using electronic health records (EHR) to deliver services. Traditionally, quality improvement initiatives evaluated services on a case-by-case basis; for example, was a procedure performed properly, were there complications, was  the patient satisfied, and was the provider properly trained? The ACA’s movement towards health care reform expands the focus on reducing individual errors to addressing system performance and community health. Through data capture and sharing, health care organizations gain the ability to use this information to analyze and advance clinical processes. For instance, through the aggregation of real-time patient data early warning systems can reduce medical emergencies, transitions to intensive care, and mortality rates. Even though the ACA does not mandate the adoption and Meaningful Use of EHRs, after 2015, all Medicare providers not participating in the EHR incentive program may be sub ject to financial penalties (Impact, 2012). Financial Incentives Financial incentives refer to monetary rewards and penalties offered to health providers for creating a stronger primary care system that expands access, provides improved quality, and delivers better health results. Under the current fee-for-service system, providers do not receive payments for time spent with a patient discussing medical histories, alternative treatment options, concerns, between visit follow-ups, or even care coordination and management; instead, reimbursements occur through procedures, such as surgeries or diagnostic testing. Under ACA, primary care physicians receive a temporary increase in both Medicare and Medicaid payments. Financial incentives are also available for providers who encourage their patients to obtain preventative care services and for patients, through the elimination of coinsurance, deductibles, and copayments for approved preventative services and tests, such as blood pressure and cancer screenings. Moreover, the ACA Medicaid expansion will p rovide over 32 million people with health coverage, resulting in improved health and less uncompensated care (Abrams, Nuzum, Mika, Lawlor, 2011). Discussion Within the world of health care economics, access to health care services becomes restricted through a fee-for-service model that authorizes third-party payers to prioritize reimbursements for the delivery of acute, episodic treatment over preventative care and wellness. As purchasers, patients have little ability to evaluate the quality of services received or  negotiate fair prices. The ACA serves as an advocate, shifting the focus of the health care system from personal health to community health. As part of this initiative, providers receive financial rewards for investing in technological improvements, such as EHR adoption. Through the development of a national HIT infrastructure, capital resource investments enable data capture and sharing. When combined with Meaningful Use incentives, providers receive encouragement to create real-time monitoring solutions to improve health and reduce costs. Together, the ACA offers a path where primary care providers have the means to devel op a stronger health care system that provides expanded access, improved quality, and increased wellness. Conclusion The United States â€Å"for-profit† health care system, conflicted with inflated costs and barriers to access, is in a process of reform. The ACA aims to correct these market failures by reducing costs, improving health, and increasing access to quality care. The change in focus from reducing clinical errors to addressing system performance and community health is an essential aim of the ACA. Through the adoption of HIT, health care providers strengthen their capital resources and increase their ability to deliver quality, cost-effective care. Once adopted, Meaningful Use incentivizes the use of community health data to establish real-time monitoring programs that detect the need for medical intervention. The ACA offers several economic initiatives to encourage providers to evolve from a for-profit mentality to one focused on health and wellness. The economics behind health care reform will redefine health care demands and the types of services delivered. Over time, the focus on preventative care and wellness will reduce the demand for costly treatments, lowering national health care costs. References Congress of the United States, Congressional Budget Office. (2008). Evidence on the costs and benefits of health information technology (2976). Retrieved from website: http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/91xx/doc9168/05-20-healthit.pdf Impact Advisors. (2012). Meaningful use stage 2: Understanding timing and penalties. Retrieved from website: http://www.impact-advisors.com/assets/news/document/ IA_Primer_on_MU_Stage_2_Timing_and_Penalties.pdf Abrams, M., Nuzum, R., Mika, S., Lawlor, G. (2011). Realizing health reform’s potential. The Commonwealth Fund. Retrieved from http://www.commonwealthfund.org/~/media/Files/ Publications/Issue%20Brief/2011/Jan/1466_Abrams_how_ACA_will_strengthen_primary_care_reform_brief_v3.pdf

Civil War Essay Example for Free

Civil War Essay Brothers fighting brothers, a country imploding in itself, the world is an antithesis of what auspicious t it is today. A country separated by gender, race, religion, and class is that really a Union? The Civil War has begun, a fight not yet for the freedom of slaves but a fight to mold two sides of a coin into one. The oppressed brethren are reluctant to fight and why shouldn’t they be through all the injustices the Union has placed upon them? Regardless, Alfred M. Green delivers a speech in an effort to persuade his brethren into fighting for the right to join the army that empathizes with his fellow brethren’s inundation, that promises commemoration and recognition for his fellow African Americans, and that promotes the Union’s battle as a righteous one. Green starts his speech down on the mat with a crowd that holds the candid opinion of not wanting to join a fight for a country that oppresses its people, enslaves its people, and imprisons its people. Nevertheless Green acknowledges his brethren’s suffering and injustice caused by the â€Å"fugitive slave-laws† and the â€Å"Dred Scott decisions† and states that ‘[their] duty is not to cavil over past grievances† but to aid the country with â€Å"burning zeal and enthusiasm†. By empathizing with the injustices the Union has committed towards the black community, Green preemptively dismisses the crowd’s probable argument and establishes a common ground to build upon later in his speech. Likewise, Green mention’s that â€Å"the brave deeds of our fathers†¦ have failed to bring us recognition† which quickly refutes the future argument that the Brethren have already sacrificed their share and establishes the point that it’s up to the blacks of that era to bring â€Å"honor† and â€Å"glory† to the African American race. After acknowledging the mistreatment the Union has committed to the free and enslaved blacks, Green emphasizes that joining the war against the South will â€Å"improve the present auspicious moment creating anew [the brethren’s] claims upon the justice and honor for the Republic†. This quote suggests that taking up arms for the Union will secure the future of free African Americans with freedom and honor. In addition, Green says, â€Å"let not the honor and glory achieved by our fathers be blasted or sullied by a want of true heroism among their sons†. Green invokes â€Å"filial piety† in the crowd by ultimately saying that the good reputation their ancestors had laid out in the Revolutionary War and the War of 1812 should not be â€Å"sullied† or â€Å"blasted† and should be preserved and built upon for this time they may secure a free future. Towards the climax of his speech, Green promotes the Union Army as God’s Army and â€Å"[he or God] will defend the right, remembering that these are other days than those of yore.† By stating God wants the audience to â€Å"take up the sword† ultimately encourages the religious brethren to join this â€Å"army of God† and gives these mistreated people hope because God wants them to succeed and gain freedom from judgment and racism imposed on their race. Green also says â€Å"[their] very presence among the troops of the North would inspire [their] oppressed brethren of the South with zeal†¦ and confidence.† Green’s intention for this quote was to evoke the righteousness of the northern audience to fight for the southern slaves who are enduring far worse hardships. Alfred M. Green recognizes the hardship his race has endured but insists that their involvement in the war will secure a future filled with honor and glory and insists that God sides with the North and trusts them to fight for and free the enslaved south. In essence, Green convincing blacks and whites to work together as equals was the leap of mankind that inspired the many immigrants and future generations to see the United States of America as the land of freedom and the home of the brave.

Analysing Leadership In The Godfather Film Studies Essay

Analysing Leadership In The Godfather Film Studies Essay The Godfather is exciting as it was upon its release in March of 1972. The statement Ill make him an offer he cant refuse still resounds with recognition in the instant. Vito Corleone was a man of morals, principle and valor in a world sorely lacking in either. Vito Corleones first name means life, or alive, and his last means lionhearted are in every way his own man. He has made his life providing people with things denied by other people, gambling, women and justice. Throughout the film, in contrast to the morality of the Don and the corruption of the State. In the wedding scene, we begin to see the relationship between the Don and the State when Tom Hagen tells him that a senator and some of the judges had called to apologize for not being there, but that theyve all sent gifts. And late in the film, it spoke very specifically about the State when Michael said that his father is no different than any other powerful man, any man whos responsible for other people, like a senator or a president. The Don is violent but not corrupt. He cannot be bought and used violence with great restraint. He approaches directly and honestly. In the film, Don is the most principled man. He rejected to participate in the drug business since it would be wrong on moral grounds even at the risk of his own life. Family, friends and integrity are far more important than mere money. The Godfather; the main character is a man who is strong, brave and highly principled to defy the power of the State. (A) Provide a synopsis of the movie relating to aspects of leadership. The storyline Guests were gathered for the wedding reception of Don Vito Corleones daughter Connie and Carlo Rizzi in 1945. Vito is known to friends and associates as Godfather. He and familys lawyer and counselor, Tom Hagen are hearing wishes for special treatment because it is tradition that a Sicilian cannot refuse a request on his daughters wedding day. The Dons youngest son Michael an adorned Marine war hero attempted to tell his girlfriend Kay Adams about his family especially his fathers criminal living; he assures her that he is not like his family. Among the guests at the celebration is the famous singer Johnny Fontaine, Corleones godson, who has come to appeal for Vitos help in landing a movie role that will rejuvenate his declining career. Jack Woltz the head of the studio, refuses to give Fontaine the part and Hagen is sent to California to heal the problem but Woltz told him that he will never cast Fontaine in the role because Fontaine had ruined a starlet that was special to Woltz. Woltz changed his mind anyway when he wakes up early the next morning, pulled back the sheets and finds the severed head of his prized $600,000 horse, Khartoum. When Hagen returns, the family meets with Virgil Sollozzo who is backed by Tattaglia, the rival family. Don Corleone was asked to finance and give political and legal protection for the importation and distribution of heroin. Corleone refused even though he could make a huge profit. The Dons eldest son, Sonny breaks ranks during the meeting. Don Corleone was angry at Sonnys disagreement in a non-family members presence, secretly reprimanded him later. Later, Don Corleone was shot down in a shooting. Tom Hagen was abducted and they used him to persuade and offer Sonny the deal offered to his father earlier. Sonny refused to think over it and issued a challenge or a war would break. They refused and instead sent Sonny Luca Brasis bulletproof vest as a sign that they had murdered him. Michael visited his father at a small private hospital. He was shocked to discover that no one was watching over him. He then realized that his father was yet again being set up to be murdered; he called Sonny for assistance; removed the Don to another room, and went to observe the entrance from outside. Michael engaged help from Enzo the baker who came to the hospital to pay his respects. Together, they managed to deceive Sollozzos men. Police cars appeared bringing the dishonest Captain McCluskey. Captain McCluskey broke Michaels jaw when Michael indirectly said that Sollozzo paid McCluskey to kill the Don. Hagen then arrived to protect Don Corleone and took Michael home. Sonny retaliated by killing Bruno Tattaglia, his son and the under-boss of Don Phillip Tattaglia. Ensuing to the attempt at the hospital on the Dons life, Sollozzo requested a meeting with the Corleones. Michael volunteered to kill both men during the meeting but the rest of the family members found it amusing but Michael persuaded them that he was serious in the killings which he feels was in the familys interest. Michael argued that McCluskey was corrupt and had illegal dealings with Sollozzo; hence he should be killed as well. Prior to the congregation in an Italian restaurant, McCluskey checked for weapons on Michael and he was clean. Michael went to the bathroom, took out a revolver and gravely shot Sollozzo then McCluskey. Michael ran and hid in Sicily. Sonny beat Carlo Rizzi for attacking the Connie who was pregnant. He threatened to kill Carlo if he battered her again. Carlo responded and plotted with Tattaglia and Don Emilio Barzini to kill Sonny. In order to ensnare Sonny, Carlo thrashed Connie again. Sonny in an enraged state drove off alone to execute his threat. He was ambushed on the way at a toll booth and shot to death in his car. In New York City, Don Corleone returned home from the hospital and was distraught to learn that Michael had killed both Sollozzo and McCluskey and that Sonny was dead. Don Corleone met with the heads of the other rival Families to bargain a ceasefire and not seek revenge for Sonnys killing. Ending the conflict was the only way to bring Michael home safely. Revenge would only drain their assets which will then threaten their survival. Vito, changing his mind on the previous decision, agreed that the Corleone family would provide political protection for the Tattaglias heroin trafficking as long as it was controlled and not sold to children. Don Corleone could figure out at the meeting that it was Don Barzini and not Tattaglia who was actually behind the gang war and Sonnys death. Michael waited patiently in Sicily for his exile to end whilst being protected by an old family friend. Michael wandered the countryside aimlessly together with the bodyguards, Carlo and Fabrizio. Michael met and fell in love with Apollonia Vitelli, the beautiful daughter of a bar owner in the village. They got married but Corleones enemies were soon aware of Michaels presence. Apollonia was killed as the couple was about to be shifted to a safer place when their car was bombed; Michael barely got away alive but spotted Fabrizio leaving the grounds hastily seconds prior to the explosion hence incriminating him in the murder plot. Michael returned home when his safety was guaranteed. A year later, he met up with his former girlfriend Kay after four years. He proposed to her and Kay accepted although she was hurt that it took him so long to contact her. With the Don semi-retired, Sonny dead and the middle brother Fredo deemed incompetent to run the family business, Michael was put in charge. He promised Kay he would legitimize the family business completely in the next five years. Peter Clemenza and Salvatore Tessio are the Corleone Familys two captains who complained that they were being shoved around by the Barzini Family and asked for consent to strike back but Michael rejected the appeal. He planned to shift the familys operations to Nevada and soon after Clemenza and Tessio may sever and form their own families. Michael promised Connies husband, Carlo, that he would be his senior man in Nevada. Tom Hagen was removed and became the familys lawyer only; with Vito serving as the consigliere. Hagen complained about his status change and questioned Michael on the new command of soldiers being secretly built under Rocco Lampone but Don Vito explained that Michael was being advised by him. Michael met with the casino boss Moe Greene in Las Vegas. Michael was rejected rudely when he offered to take over Greene. He believed the Corleones were fragile and that he could obtain a better pact from Barzini. Fredo sided with Moe when Moe and Michael were negotiating intensely. Later, Michael cautioned Fredo to never again go against the family. When Michael returned home, Vito told him his expectation that the Familys enemies would attempt to execute Michael by using a trusted link to collaborate a meeting on a ploy for assassination. Vito never meant for Michael to lead a life of crime and hoped that his youngest son would hold a lawful power as a government officer. Soon after, Vito crumpled and died in his tomato garden whilst playing with his grandson Anthony. Tessio suggested meeting with Barzini at the burial which made Tessio as the defector that Vito was anticipating. Michael organized a series of murders while he became the godfather to Connie and Carlos newborn son at the church to happen at the same time. Don Stracci: shot down together with his men in a lift. Moe Greene: was shot in the eye by an unidentified assassin while being massaged. Don Cuneo: shot dead by Willi Cicci: while trapped in a revolving door and Don Tattaglia: murdered in his bed by Rocco Lampone and an anonymous associate. Don Barzini: was shot along with his bodyguard and driver, by Al Neri, disguised in his old police uniform. After the baptism, Tessio thought he was on the way with Hagen to the meeting between Michael and Barzini which he had arranged. He was however circled by Willi Cicci and other hired men instead as Hagen moved away. Tessio realized that Michael had discovered his treachery. He told Hagen that he had always revered Michael, and that his disloyalty was for business only. He asked Tom to release him for old times sake, but Tom could not do so. In the mean time, Michael faced Carlo about Sonnys murder and compelled him to admit his involvement in the ambush. Michael assured Carlo he would not be killed, but excluded from all family business. He gave Carlo a plane ticket to banish himself to Las Vegas. Nonetheless, he was killed on Michaels orders by Clemenza, while getting into the car which was headed for the airport. A frantic Connie confronted Michael and accused him of killing Carlo. Kay questioned Michael about Connies charge but he declined to respond, telling her again never to question about his business. She persisted and Michael lied; assuring her that he did not know and has no part in Carlos death. Kay believed him and was felt relieved. Clemenza and the new captains Rocco Lampone and Al Neri pay their respects to Michael. Clemenza bowed to Michael greeted him as Don Corleone. Michael became the new Godfather. Who is or are the leader/s in the movie Vito Corleone, Sonny Corleone, Michael Corleone The leader/s role in the movie Negotiating, Discussing, Delegating and Instructing (B) Explain the context for each incident relating to leadership aspects in the synopsis. Incidents within the movie involving the leader/s (1) Don Corleone telling Johnny Fontaine that he would help him to be the star in the movie by offering Jack Woltz something that he cant refuse. Leadership in solving problems. (2) Sollozzo had asked Don Corleone to finance and give political and legal protection for the distribution of heroin but Corleone refused even if he could make huge profits saying that his political influence would be in jeopardy by a moving into the narcotics business. Leadership in being responsible to ensure the safety of others. (3) When Sonny who had earlier advocated the family to enter the drug trade broke ranks during the meeting, his father, angry at Sonnys rebellion in a non-family members presence, reprimanded him privately later. Leadership in solving matters/rebuking subordinates not in front of external parties. (4) Michael visited his dad at the hospital and became suspicious when there was no one guarding the Don. He realized that there was yet another murder being set up and he called Sonny for help and removed the Don to another room. Michael enlisted aid from Enzo the baker who had gone to the hospital to give his respects. Together, they managed to deceive the killers. Leadership in recognizing a situation and deciding to solve them. (5) Upon the an assassination attempt on Don Corleone at the hospital, Sonny retaliated by killing Bruno Tattaglia, son and the under-boss of Don Phillip Tattaglia. Leadership in taking the responsibility to solve the problems themselves. (6) When Don Corleone came home from the hospital; found out that Michael had killed both Sollozzo and McCluskey and Sonnys death, Don Corleone met with the heads of the rival families to confer a ceasefire instead of seeking revenge for Sonnys killing. Ending the conflict was the only way to bring Michael home safely. Revenge would exhaust their assets and threaten their survival. Vito agreed that the Corleone family would provide political protection for the Tattaglias heroin trafficking as long as it was restricted and not sold to children. Leadership in recognizing and finding an amicable way to solve the problems. (7) Sonny severely beat Carlo Rizzi for viciously attacking the pregnant Connie, and threatened to kill him if he ever battered her again. Leadership in taking the lead and meting out the punishment. Incidents and the leader/s interaction within the context of the movie (1) Johnny Fontaine, Corleones godson came from Hollywood to lobby Vitos help in getting a movie role to revive his failing career. Jack Woltz, refused to give Fontaine the part. Don Corleone t Hagen to discuss with Woltz and assured Fontaine he would get the role. (2) Don Corleone was asked to finance and give political legal protection for distributing heroin. Even with a huge profit to be made, Corleone refused. (3) Sonny who had urged the family to enter the drug trade broke ranks during the meeting between Sollozzo and the Corleone Family. The Don, angry at Sonnys disagreement in a non-family members presence, secretly admonished him later. (4) Michael asked for help from Enzo the baker who had gone to the hospital to give his respects. Together, they managed to deceive Sollozzos men. Hagen then arrived with guns to protect Don Corleone and took Michael home. Sonny retaliated by killing Bruno, the son and Don Phillip Tattaglia (5) Michael wanted to kill both men during the meeting and he persuaded them that he was serious on the killings. (6) McCluskey searched Michael for weapons before the meeting in an Italian restaurant, and did not find any weapons. Michael excused himself to go to the bathroom where he got back a revolver and upon coming to the table, seriously shot and killed Sollozzo followed by McCluskey. (7) Sonny beat Carlo Rizzi for viciously attacking the Connie, and told him he would kill him if he ever mistreated her again. Angry Carlo then plotted with Tattaglia and Don Emilio Barzini, the Corleones head rivals, to kill Sonny. Carlo thrashed Connie again in order to trap Sonny. In an angry state, Sonny drove off alone to execute his warning. He was ensnared on the way at a toll booth and shot to death in his car. (8) Don Corleone met with the heads of the rival families to discuss on a ceasefire and not seek revenge for Sonnys killing. Ending the conflict was the only way to bring Michael home safely. (9) The Don is now semi-retired, Sonny dead and brother Fredo deemed incompetent to run the family business, Michael was put in charge. He promised Kay he would legitimize the family business completely within five years. (10) Michael promised Carlo that he would be his lead man in Nevada. Hagen was removed as the consigliere and became the familys lawyer only; with Vito serving as the consigliere. (11) Vito Corleone explained to Hagen that Michael was being guided by him. (12) Fredo sided with Moe during the intense negotiation. Michael cautioned Fredo never to take sides with anyone other than the family again. (13) Vito told Michael that he expected the Familys enemies would try to kill Michael by using a link to collaborate a meeting on a pretext for murder. (14) Michael organized a series of murders while attending the baptism of Connie and Carlos newly born son at the church to happen at the same time. Don Stracci: shot down together with his men in a lift by Clemenza. Moe Greene: shot through the eye by an unidentified assassin while being massaged. Don Cuneo: shot dead by Willi Cicci while trapped in a revolving door and Don Tattaglia: murdered in his bed along by Rocco Lampone and an anonymous associate. Don Barzini: shot along with his bodyguard and driver by Al Neri in his old police uniform. (15) Michael faced Carlo about Sonnys murder and compelled him to admit his involvement in the ambush. Michael assured Carlo he would not be killed but excluded from all the familys businesses. He gave Carlo a plane ticket to banish himself to Las Vegas. (16) Connie confronted Michael and accused him of killing Carlo. Kay questioned Michael about Connies charge but he declined to respond, telling her again never to query him about the business. She persisted and Michael lied; assuring her that he played no role in Carlos death. Kay understood him and was relieved. Know your leader/s behavior and characteristics Leadership is behavior of an individual when he is directing the activities of a group towards a shared goal. A leader is someone who sets direction in an effort to influence people to follow that direction. (C) Describe and discuss why the leadership behavior was effective or ineffective Leadership behaviors like task oriented; relations oriented; participative leadership (1) Sonny could keep things as they were but he was unable to make certain situation better. He was not able to make wise decision and always acted rashly. For example when his sister was attacked for the second time. He did not think things through and rushed off alone. As a result, he got himself killed. Sonny was not innovative. He needed someone else to make decision for him and for him to carry things out. He was able to sustain but could not improve them. (Ineffective) (2) Vito Corleone possessed the traits of a leader which were effective. He made decisions which he thinks is the best for the family regardless if the others are not in agreement with him. As a leader, he showed that he was thinking of the long term future. For example when he refused to cooperate with Tattaglia on the heroin trafficking. He was thinking of the familys future ethics and values. (Effective) (3) Michael made the proposal to kill the police chief and head rival. He put the police chiefs motives in the newspaper to control the damage. He removed Hagen as the familys chief advisor since Hagen was always protesting against the way Michael made his decisions. (Effective) Change agent capabilities (1) Sonny was not able to grasp changes and improve them. He could manage to make wise decisions and needed others to decide for him. He could only sustain whatever was at hand. Sonny was more of a manager who could maintain things. (2) Vito Corleone was a leader who would adopt changes for the family even if the others are not in sync with his decisions. He has the leadership traits in him to lead the family well into the future. He forethought what would be in the best interest for the family in the next ten years rather than short term. (3) Michael many changes and ideas to make the Familys business legal in five years as he promised Kay before he married her. He proposed on the new idea to kill the corrupt police chief who was working with the familys rival even though others were amused by his suggestion. He removed Hagen from the advisor role when Hagen was always criticizing and questioning his new ideas. Able to support, able to develop new ideas and recognizing achievement (1) Sonnys style of leadership was ineffective because even though he was able to support new ideas, he was not able to develop the ideas to make them better. He could not make wise decision for the family. He did not think situations thoroughly and would just rush off when there was family crisis. He was not inventive and did not have a thought process of a leader. He could achieve when decisions were made for him. He would exclude other people or matters involved when tackling the problems or issues. He could sustain the situations or conditions but could not improve or make the better. (2) Vito Corleone style of leadership was effective because he could adopt and adapt to new changes or ideas. He was not a person who would just maintain a situation. He would create new improvements in order to achieve his goals. When he was asked by Tattaglia to help in the drug trafficking business, he refused even though he knew it would be benefit the Family greatly. He envisioned the future and hence rejected to cooperate in the business. Even when Sonny rebuked and sided with the other party, he tolerated the outburst but stayed true to his decision. He showed his leadership in adopting changes well after the killings and death of Sonny from his earlier refusal to assist. Upon his hospitalization and many attempts to assassinate him, he relinquished his role as the Don and became an advisor to Michael in the running and leading of the Familys business. He was ethical and declined to get involved in unnecessary killings especially when the younger generations are concerned. (3) Michael Corleones style of leadership was effective because he was working towards improving the familys business and making it better. He promised Kay he would legitimize the business in five years and he tried hard to ensure that it happened. He made the proposal to kill the police chief and head rival and later spread the police chiefs actual motives in the newspapers as a measure to control the damage. Hagen who was a great manager of the familys business could not understand Michaels new ideas and thoughts protested. In response to Hagens actions, Michael relegated his advisor position in the family to just family lawyer despite Hagens complains. Michael was able to achieve his goals working with subordinates who are willing to cooperate and follow his lead. He was able to lead and manage the family to greater success and made himself renown and respected by his rivals. (D) Identify and explain at least two different incidents involving the same leader(s). If the incidents involve two individuals or a group making a decision, leadership behavior by the different individuals can be identified. Executive summary of the two different selected incidents In the opening scene when a funeral director explained to Don Corleone about the men who had beaten and mutilated his daughter got deferred sentences and how the State buffed him the justice which he thought he deserved. He went to see Don Corleone seeking fairness and initially had wanted to ask Corleone to kill them but the Don said out that would not be justified because the daughter was still alive. Bonasera tried to bribe him with money but Corleone was above that. The only price to him for supplying justice was friendship because some day, he would call upon Bonasera to do a service for him. He refused to do murder for money for Bonasera because that would not be justice. (2) The Don was not corrupt but violent. Even though he bought politicians, he himself could not be bought. He used violence but he is not evil. He refused to acquiesce to the State. He used this violence with restraint. The same thing happened with the movie director. The Don first offered friendship to do some specific services; that is making his godson as the star in his new movie but the director refused reasons and in the end woke up with a dead horses head in his bed. The Dons approach was direct and honest. He was the most principled man in the film. He refused to kill in the Bonaseras case because that would not be fair and he declined to take part in Sollozzos drug business, because that would be wrong. He told Sollozzo that drugs were a dirty business. It did not make any difference to him what people do for a living but the drug business is dangerous. Making decision within team, group and individual setting (1) The family met with Virgil Sollozzo who asked Don Corleone for financing, political and legal backings in importing and distributing the heroin. Corleone refused despite knowing the huge profit that could be made explaining that his political pressure would be compromised by going into the drug trade. The Dons eldest son Sonny, who had earlier supported the family to enter the drugs trade, broke ranks in the meeting and queried Sollozzos assurances and guarantees as to the Corleone Familys investment by the Tattaglia Family. Don Corleone was angry at Sonnys opposition in a non-family members presence, reproached him later in private. Don Corleone then sent Luca Brasi to penetrate Sollozzos organization and revert with information. Brasi was stabbed in the hand and subsequently garroted by an assassin. (2) Michael went to visit his father at the private hospital. He was alarmed to find out that no one was watching over him. He then realized that his father was yet again being set up to be murdered; hence he called Sonny for assistance; removed the Don to another room, and went to observe the entrance from outside. Michael engaged help from Enzo the baker who had gone to the hospital to give his respects. Together, they managed to deceive Sollozzos men. Police cars appeared bringing the corrupt Captain McCluskey. Captain McCluskey hit and broke Michaels jaw when Michael implied that Sollozzo paid McCluskey to net Vito Corleone. Hagen arrived with licensed guns to protect Don Corleone and took Michael home. In retaliation, Sonny killed Bruno Tattaglia, son and the under-boss of Don Phillip Tattaglia. Charismatic and transformational roles (1) Vito Corleones first name meant life, and his last name meant a man with a lions heart and who was in every way his own person. He said to his son Michael in the film, I refused to be a fool dancing on a rope held by all those people and he has made his life providing people with things that those people had deprived them of among them gambling, women and justice. (2) Michael waited patiently in Sicily for his exile to end whilst protected by an old family friend. Michael roamed the countryside aimlessly together with the bodyguards, Carlo and Fabrizio Michael fell in love with Apollonia Vitelli, the beautiful daughter of a bar owner in the small village. They got married but Corleones enemies were soon aware of Michaels presence. Apollonia was killed as the couple was about to be shifted to a safer place when their car was bombed; Michael barely got away alive but spotted Fabrizio leaving the grounds hastily seconds prior to the explosion hence incriminating him in the murder plot. Michael returned home when his safety was guaranteed. A year later, he met up with his former girlfriend Kay. He wanted to marry her and Kay accepted his proposal although it took him so long to contact her. The Don who was semi-retired; Sonny dead and the middle brother Fredo deemed incompetent to run the family business, Michael was put in charge. He promised Kay he would legitimize the family business completely in the next five years. Peter Clemenza and Salvatore Tessio, the Corleone Familys captains were not happy being shoved around by the Barzini Family and asked for consent to strike back but Michael rejected the appeal. He planned to shift the familys operations to Nevada and soon after Clemenza and Tessio may sever and form their own families. Michael promised Connies husband, Carlo, that he would be his lead man in Nevada. Hagen was removed as the consigliere and became the familys lawyer only; with Vito serving as the consigliere. In private, Hagen complained about his status change and questioned Michael on the new command of defense force being secretly cultivated under Rocco Lampone. Don Vito explained that Michael was being advised by him. Michael met with the Moe Greene in Las Vegas. Michael was rejected rudely when he offered to take over the casino. Greene believed the Corleones were fragile and that he could obtain a better pact from Barzini. Fredo sided with Moe when Moe and Michael were negotiating intensely. Later, Michael cautioned Fredo to never anyone against the family ever again. When Michael came home, Vito explained that the familys enemies would endeavor to execute Michael by using a trusted link to collaborate a meeting on a ruse for assassination. Vito also said that he had never meant for Michael to lead a life of crime and hoped that his youngest son would hold a legitimate government office. Soon after, Vito crumpled and died in his tomato garden. Michael then arranged for a sequence of murders to take place at the same time while he was attending Connie and Carlos newborn sons baptism at the church. Critically analyze each of the two or more incidents and consider other options the leader (s) could have considered and made (30%) Participative leadership, delegation and empowerment (1) Sonny could have delegated the task of killing or teaching his sisters to his men instead of rushing off alone to handle the crisis. His death caused the family to be in a worse situation then before. (2) Michael could have been taken seriously by the other family members when he suggested killing the police chief and head rival. He should have participated earlier in the familys activities and not only after his father had assassination attempts made upon him. It could have saved Sonnys life if Michael was around to make decisions. Don Corleone should have foreseen Michaels capabilities and empower him to take the lead in the family. Power and influence Vito Corleone was a strong man; sufficiently brave and principled enough to stand up to challenge the power of the State. The type of man we all wished to be and emulate. Vito Corleones family, friends and integrity were far more important than money. Managerial traits and skills Sonny was not able to make wise decisions for his family. He has no clear thought process. For example when his sister was attacked by the husband for the second time, he just rushed off during the crisis. He was a more a manager where he carried out decisions made by others. He could not make anything better because he was not innovative enough to do so. Leading change Michael did not want to get involved in the Familys activities and happy to be a civilian. However when his father, Don Corleone was threatened and had many assassination attempts made on him, his brother Sonny killed and his elder brother deemed incompetent to lead, he had no choice but to take over the realm with Don Corleone as his advisor. He promised Kay before he married her that he would make the business legitimate in five years He planned to shift the familys operations to Nevada and soon after Clemenza and Tessio may sever and form their own families. Michael promised to make Connies husband his right lead man in Nevada. Hagen was removed and became the familys lawyer only; with Vito serving as the consigliere. Hagen complained about his status change and questioned Michael on the new command of defense force. Don Vito explained to Hagen that Michael was being counseled by him. Michael met with the casin